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Online Library: Scurvy

The following pages provide an overview of the most recent research and clinical studies about the health benefits of micronutrients in fighting scurvy. This collection of scientific facts proves that anyone who privately or publicly questions the health value of micronutrients does not serve YOUR health, or the health of the people, but rather the multi-billion dollar investment 'business with disease' based on patented pharmaceutical drugs.

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Ascorbic Acid Prevents Acute Myocardial Infarction Induced by Isoproterenol in Rats: Role of Inducible Nitric Oxide Synthase Production

Source: Journal of molecular histology 2009; 40(2): 99-105

Author: Ribeiro D.A., Buttros J.B., Oshima C.T., Bergamaschi C.T., Campos R.R.

Affiliation: Department of Biosciences, Federal University of Sao Paulo, UNIFESP, Av. Ana Costa, 95-Vila Mathias, Santos, SP 11060-001, Brazil.

Abstract: The goal of this study was to investigate whether sub-chronic anti-oxidant treatment with ascorbic acid (vitamin C) is able to protect the heart against myocardial infarction. The effects of vitamin C treatment on the histopatological changes and immunohistochemistry for p53, COX-2 and iNOS were evaluated in rats submitted to acute myocardial infarction induced by isoproterenol (ISO). Male Wistar rats (n = 32) were divided into four groups. An amount of 150 mg/kg of isoproterenol was administered for two consecutive days. The rats were treated with Vit C once a day (150 mg/kg, orally) for seven consecutive days. In the day 5 and 6 the rats from group ISO + Vitamin C were submitted to acute administration of ISO third minutes after vitamin C treatment. The results pointed out that treatment with Vit C showed mild degenerative changes of myocardial tissue in ISO group. Also, the antioxidant was able to decrease the iNOS expression in rats treated with vitamin C. Taken together, our results suggest that chronic Vit C administration was able to prevent the myocardial infarction induced by ISO as a result of iNOS downregulation. Certainly, this finding offers new insights into the mechanisms underlying the relation between oxidative stress and cardiac mortality after myocardial infarction.

Cardioprotective Actions of Ascorbic Acid During Isoproterenol-Induced Acute Myocardial Infarction in Rats

Source: Pharmacology 2009; 84(1): 29-37

Author: Buttros J.B., Bergamaschi C.T., Ribeiro D.A., Fracalossi A.C., Campos R.R.

Affiliation: Cardiovascular Division, Department of Physiology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil.

Abstract: The present study tested whether or not acute antioxidant treatment with vitamin C is able to protect the heart during myocardial infarction. The effects of vitamin C on the autonomic balancing of the heart and on the histopathological and immunohistochemical changes in response to isoproterenol administration (ISO) were evaluated. The study concludes that vitamin C administration proved to be effective in reducing the extent of myocardial damage during ISO-induced myocardial infarction in rats associated with an iNOS downregulation and improving the autonomic balancing of the heart.

Different Effects of Ascorbate Deprivation and Classical Vascular Nitrate Tolerance on Aldehyde Dehydrogenase-Catalysed Bioactivation of Nitroglycerin

Source: British Journal of Pharmacology 2009; 156(8): 1248-55

Author: Wenzl M.V., Wolkart G., Stessel H., Beretta M., Schmidt K., Mayer B.

Affiliation: Department of Pharmacology and Toxicology, Karl-Franzens-Universitšt Graz, Graz, Austria.

Abstract: Vascular tolerance to nitroglycerin (GTN) may be caused by impaired GTN bioactivation due to inactivation of mitochondrial aldehyde dehydrogenase (ALDH2). As relaxation to GTN is reduced but still sensitive to ALDH2 inhibitors in ascorbate deficiency, this study compared the contribution of ALDH2 inactivation to GTN hyposensitivity in ascorbate deficiency and classical in vivo nitrate tolerance. Guinea pigs were used in the study and fed standard or ascorbate-free diet for 2 weeks. Reversibility was tested by feeding ascorbate-deficient animals standard diet for 1 week. Nitrate tolerance was induced by subcutaneous injection of 50 mg x kg(-1) GTN 4 times daily for 3 days. Ascorbate levels were determined in plasma, blood vessels, heart and liver. GTN-induced relaxation was measured as isometric tension of aortic rings; vascular GTN biotransformation was assayed as formation of 1,2- and 1,3-glyceryl dinitrate (GDN). The results indicate that nitrate tolerance is associated with ALDH2 inactivation, whereas ascorbate deficiency possibly results in down-regulation of ALDH2 expression.

Vitamin C Supplementation Lowers Serum Low-Density Lipoprotein Cholesterol and Triglycerides: a Meta-Analysis of 13 Randomized controlled Trials

Source: Journal of Chiropractic Medicine 2008; 7(2): 48-58

Author: McRae MP

Affiliation: Assistant Professor, Department of Physiology and Biochemistry, National University of Health Sciences, Lombard, IL 60148.

Abstract: The purpose of this study was to provide a comprehensive meta-analysis of randomized controlled trials to investigate the effect of vitamin C supplementation on LDL and HDL cholesterol as well as triglycerides in patients with hypercholesterolemia. Thirteen randomized controlled trials published between 1970 and June 2007 were identified using Medline and a manual search. From the 13 trials, 14 separate group populations with hypercholesterolemia and who were supplemented with at least 500 mg/d of vitamin C for between 3 and 24 weeks were entered into the meta-analysis. This meta-analysis used a random-effects model; and the overall effect sizes were calculated for changes in LDL and HDL cholesterol, as well as triglyceride concentrations. The pooled estimate of effect for vitamin C supplementation on LDL and HDL cholesterol was -7.9 mg/dL (95% confidence interval [CI], -12.3 to -3.5; P = .000) and 1.1 mg/dL (95% CI, -0.2 to 2.3; not significant), respectively. The pooled estimate of effect for vitamin C supplementation on triglycerides was -20.1 mg/dL (95% CI, -33.3 to -6.8; P < .003). The study concludes that supplementation with at least 500 mg/d of vitamin C, for a minimum of 4 weeks, can result in a significant decrease in serum LDL cholesterol and triglyceride concentrations. However, there was a nonsignificant elevation of serum HDL cholesterol.

Antioxidant Vitamins Intake and the Risk of Coronary Heart Disease: Meta-Analysis of Cohort Studies

Source: European Journal of Cardiovascular Prevention and Rehabilitation 2008; 15(1): 26-34

Author: Ye Z., Song H.

Affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.

Abstract: This study undertook a meta-analysis of cohort studies to examine the relations between antioxidant vitamins (vitamins C, E, and beta-carotene) and CHD risk. All the relevant cohort studies were included if they provided a relative risk and corresponding 95% confidence interval (CI) of CHD in relation to antioxidant vitamins intake from diet or supplement. Fifteen cohort studies were identified involving a total of 7415 incident CHD cases and 374,488 participants with a median follow-up of approximately 10, 8.5, and 15 years for vitamins C, E, and beta-carotene, respectively. Pooled estimates across studies were obtained by random-effects model. The potential sources of heterogeneity and publication bias were also estimated. In the dose-response meta-analysis, each 30 mg/day increase in vitamin C, 30 IU/day increase in vitamin E, and 1 mg/day increase in beta-carotene yielded the estimated overall relative risk for CHD of 1.01 (95% CI, 0.99-1.02), 0.96 (95% CI, 0.94-0.99), and 1.00 (95% CI, 0.88-1.14), respectively. These findings in this meta-analysis suggest that an increase in dietary intake of antioxidant vitamins has encouraging prospects for possible CHD prevention.

Oral Ascorbic Acid in Combination with Beta-Blockers is More Effective than Beta-Blockers Alone in the Prevention of Atrial Fibrillation after Coronary Artery Bypass Grafting

Source: Texas Heart Institut Journal 2007; 34(3): 268-74

Author: Eslami M., Badkoubeh R.S., Mousavi M., Radmehr H., Salehi M., Tavakoli N, Avadi M.R.

Affiliation: Department of Cardiovascular, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 14197-33141, Iran.

Abstract: Because adrenergic beta antagonists are not sufficient to prevent atrial fibrillation after coronary artery bypass grafting, this prospective, randomized trial was designed to evaluate the effects of ascorbic acid as an adjunct to beta-blockers. Fifty patients formed our ascorbic acid group, and another 50 patients formed our control group. All patients were older than 50 years, were scheduled to undergo coronary artery bypass grafting, and had been treated with beta-blockers for at least 1 week before surgery. The mean age of the population was 60.19+/-7.14 years; 67% of the patients were men. Patients in the ascorbic acid group received 2 g of ascorbic acid on the night before the surgery and 1 g twice daily for 5 days after surgery. Patients in the control group received no ascorbic acid. Patients in both groups continued to receive beta-blockers after surgery. Telemetry monitoring was performed in the intensive care unit, and Holter monitoring was performed for 4 days thereafter. The incidence of postoperative atrial fibrillation was 4% in the ascorbic acid group and 26% in the control group (odds ratio, 0.119; 95% confidence interval, 0.025-0.558, P = 0.002). The study concludes that ascorbic acid is effective, in addition to being well-tolerated and relatively safe. Therefore, it can be prescribed as an adjunct to beta-blockers for the prophylaxis of post-bypass atrial fibrillation.

Vitamin C Restores the Contractile Response to Dobutamine and Improves Myocardial Efficiency in Patients with Heart Failure after Anterior Myocardial Infarction

Source: American Heart Journal

Author: Shinke T., Shite J., Takaoka H., Hata K., Inoue N., Yoshikawa R., Matsumoto H., Masai H., Watanabe S., Ozawa T., Otake H., Matsumoto D., Hirata K., Yokoyama M.

Affiliation: Division of Cardiovascular and Respiratory Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.

Abstract: This study hypothesized that the antioxidant vitamin C may help reverse hyporesponsiveness to beta-adrenergic stimulation and improve myocardial efficiency in patients with heart failure (HF) after myocardial infarction (MI). Nineteen patients with mild to moderate HF due to previous MI (mean left ventricular [LV] ejection fraction 39%) were instrumented with conductance and coronary sinus thermodilution catheters. Left ventricular contractility, expressed as E(es), the slope of end-systolic pressure-volume relationship, and mechanical efficiency, expressed as the ratio of LV stroke work (SW) to myocardial oxygen consumption (MVO2), were measured in response to the intravenous infusion of dobutamine (4 microg/kg per min) before (Dob) and during (Dob + Vit C) the infusion of vitamin C (2.0-g bolus injection and subsequent 50-mg/min infusion through the jugular vein) (vitamin C group, n = 10). The study concludes that the administration of the antioxidant vitamin C enhances the contractile response to dobutamine and improves myocardial efficiency in patients with HF.

Effect of Hyperoxia and Vitamin C on Coronary Blood Flow in Patients with Ischemic Heart Disease

Source: Journal of Applied Physiology 2007; 102(5): 2040-5

Author: McNulty P.H., Robertson B.J., Tulli M.A., Hess J., Harach L.A., Scott S., Sinoway L.I.

Affiliation: Div. of Cardiology, Penn State College of Medicine, Hershey, Pennsylvania, USA.

Abstract: The aim of this study was to determine the degree to which coronary tone responds to acute changes in ambient levels of oxidants and antioxidants in vivo in a clinical setting. The effect of an acute oxidative stress (breathing 100% oxygen) on coronary capacitance artery diameter (quantitative angiography) and blood flow velocity through the coronary microcirculation (intracoronary Doppler ultrasonography) were measure before and after treatment with the antioxidant vitamin C (3-g intravenous infusion) in 12 IHD patients undergoing a clinical coronary interventional procedure. Relative to room air breathing, 100% oxygen breathing promptly reduced coronary blood flow velocity by 20% and increased coronary resistance by 23%, without significantly changing the diameter of capacitance arteries. Vitamin C administration promptly restored coronary flow velocity and resistance to a slightly suprabasal level, and it prevented the reinduction of coronary constriction with rechallenge with 100% oxygen. This suggests that acute oxidative stress produces prompt and substantial changes in coronary resistance and blood flow in a clinical setting in patients with IHD, and it suggests that these changes are mediated by vitamin C-quenchable substances acting on the coronary microcirculation. This observation may have relevance for clinical practice.

Effect of Ascorbic Acid Supplementation on Certain Oxidative Stress Parameters in the Post Reperfusion Patients of Myocardial Infarction

Source: Molecular and Cellular Biochemistry 2006; 290(1-2): 153-8

Author: Bhakuni P., Chandra M., Misra M.K.

Affiliation: Department of Biochemistry, Lucknow University, Lucknow 226007, India.

Abstract: Reperfusion injury causes oxidative stress thereby resulting in an imbalance between oxidant-antioxidant systems. In the present communication, the effect of ascorbic acid supplementation has been studied on certain oxidant and antioxidant parameters in the blood of the patients with myocardial infarction before and after thrombolysis. In patients after thrombolysis, the activity of antioxidant enzyme, superoxide dismutase, in the blood was found to be significantly reduced where as the activity of the oxidant enzyme, xanthine oxidase, was found to be significantly increased. Malondialdehyde levels, the index of free radical mediated damage, was also found to be significantly elevated in thrombolysed patients compared to the patients before thrombolysis. Supplementation of vitamin C to the post reperfusion patients restored these parameters back to normal or near normal levels.

Effect of Ascorbic Acid on Prevention of Hypercholesterolemia Induced Atherosclerosis

Source: Molecular and Cellular Biochemistry 2006; 285(1-2): 143-7

Author: Das S., Ray R. Snehlata., Das N., Srivastava L.M.

Affiliation: Department of Biochemistry, Sir Ganga Ram Hospital, New Delhi, India.

Abstract: The notion that oxidation of lipids and propagation of free radicals may contribute to the pathogenesis of atherosclerosis is supported by a large body of evidence. To circumvent the damage caused by oxygen free radicals, antioxidants are needed which provide the much needed neutralization of free radical by allowing the pairing of electrons. This study have investigated the effect of ascorbic acid, a water soluble antioxidant on the development of hypercholesterolemia induced atherosclerosis in rabbits. Rabbits were made hypercholesterolemic and atherosclerotic by feeding 100 mg cholesterol/day. Different doses of ascorbic acid were administered to these rabbits. Low dose of ascorbic acid (0.5 mg/100 g body weight/day) did not have any significant effect on the percent of total area covered by atherosclerotic plaque. However, ascorbic acid when fed at a higher dose (15 mg/100 g body weight/day) was highly effective in reducing the atherogenecity. With this dose the percent of total surface area covered by atherosclerotic plaque was significantly less (p < 0.001). This suggests that use of ascorbic acid may have great promise in the prevention of hypercholesterolemia induced atherosclerosis.

Determination of Ascorbic and Dehydroascorbic Acid Concentration Using HPLC Method in Smokers with Stable Coronary Artery Disease Scheduled for Coronary Artery Bypass Grafting (CABG)

Source: Przegl Lek 2005; 62(10): 1054-7

Author: Kleszczewska E., Wiszowata A., Lisowski P.

Affiliation: Zakład Chemii Ogólnej i Nieorganicznej Instytutu Chemii Uniwersytetu w Białymstoku.

Abstract: Ascorbic acid is necessary in redox processes taking place in cell. It is reversibly oxidized to dehydroascorbic acid and partially metabolized to inactive sulphide and oxalic acid, which is expelled in urine. It is well absorbed from the digestive system and easily reaches the tissues. Healthy organism contains 1.5 g of ascorbic acid and daily requirement for ascorbic acid is estimated for 30-100 mg. Ascorbic acid is not synthesized by humans, but it is an essential dietary vitamin for the species. Ascorbic acid is used in treatment deficiency in daily demand for vitamin C, caused by improper diet, poor absorption or cigarette smoking. It is used in large doses in general weakness, infectious diseases and during the recovery period. Positive results have been obtained after therapy with vitamin C of Mollera-Barlowa disease, Schonlein-Henoch disease, Werlhof disease, haemophilia and also in patients with stable coronary artery disease. However, it seems that the complexity of the oxidant-antioxidant system makes the question of participation of vitamin C (and other scavengers of free radicals) in pathogenesis of diseases is still open.

Effects of vitamin C on Intracoronary L-Arginine Dependent Coronary Vasodilatation in Patients with Stable Angina

Source: Heart 2005; 91(10): 1319-23

Author: Tousoulis D., Xenakis C., Tentolouris C., Davies G., Antoniades C., Crake T., Stefanadis C.

Affiliation: Athens University Medical School, Athens, Greece.

Abstract: The objective of this study was to assess the effects of intravenous vitamin C administration on the vasomotor responses to intracoronary L-arginine infusion in epicardial coronary arteries. 28 patients with coronary artery disease and stable angina were enrolled in the study. Eight patients received intracoronary infusions of 150 micromol/min L-arginine before and after intravenous infusion of vitamin C, 10 patients received intracoronary infusions of 150 micromol/min L-arginine before and after intravenous infusion of normal saline, and 10 patients received intracoronary normal saline before and after intravenous infusion of vitamin C. The diameter of proximal and distal coronary artery segments was measured by quantitative angiography. The results show that co-infusion of vitamin C and L-arginine dilated proximal coronary segments by 8.68 (1.40)% (p < 0.01 v normal saline, p < 0.01 v L-arginine) and distal segments by 13.07 (2.15)% (p < 0.01 v normal saline, p < 0.01 v L-arginine). Intravenous infusion of vitamin C caused a borderline increase in proximal and distal coronary segment diameters (1.93 (0.76)% and 2.09 (1.28)%, respectively, not significant). The study concludes that L-arginine dependent coronary segment vasodilatation was augmented by the antioxidant vitamin C in patients with coronary artery disease. Thus, vitamin C may have beneficial effects on nitric oxide bioavailability induced by L-arginine.

Oral Vitamin C Administration Reduces Early Recurrence Rates After Electrical Cardioversion of Persistent Atrial Fibrillation and Attenuates Associated Inflammation

Source: International Journal of Cardiology 2005; 102(2): 321-6

Author: Korantzopoulos P., Kolettis T.M., Kountouris E., Dimitroula V., Karanikis P., Pappa E., Siogas K., Goudevenos J.A.

Affiliation: Department of Cardiology, G. Hatzikosta General Hospital, 45001 Ioannina, Greece.

Abstract: The aim of this study was to examine the potential benefit of vitamin C on the early recurrence rates and on inflammatory indices after successful cardioversion of persistent AF, as well as to investigate the time course of changes in these indices post-cardioversion. In this study prospectively 44 consecutive patients were examined after successful electrical cardioversion of persistent AF. All patients received standard treatment and were randomised in one to one fashion to either oral vitamin C administration or no additional therapy. The patients were followed up for 7 days successive measurements of white blood cell (WBC) count, C-reactive protein (CRP), fibrinogen, and ferritin levels were performed. The results show that one week after successful cardioversion, AF recurred in 4.5% of patients in the vitamin C group and in 36.3% of patients in the control group (p=0.024). Compared to baseline values, inflammatory indices decreased after cardioversion in patients receiving vitamin C but did not change significantly in the control group. A significant variance was found in the serial measurements of WBC counts (F=5.86, p=0.001) and of fibrinogen levels (F=4.10, p=0.0084) in the two groups. In the vitamin C group CRP levels were lower on the seventh day (p<0.05). CRP and fibrinogen levels were higher in patients who relapsed into AF compared to patients who maintained sinus rhythm (F=2.77, p=0.044 and F=3.51, p=0.017, respectively). These findings suggest that vitamin C reduces the early recurrence rates after cardioversion of persistent AF and attenuates the associated low-level inflammation. These effects indicate that therapeutic approaches targeting at inflammation and oxidative stress may exert favourable effects on atrial electrical remodeling.

Antioxidant Vitamins and Coronary Heart Disease Risk: a Pooled Analysis of 9 Cohorts

Source: The American Journal of Clinical Nutrition 2004; 80(6): 1508-20

Author: Knekt P., Ritz J., Pereira M.A., O'Reilly E.J., Augustsson K., Fraser G.E., Goldbourt U., Heitmann B.L., Hallmans G., Liu S., Pietinen P., Spiegelman D., Stevens J., Virtamo J., Willett W.C., Rimm E.B, Ascherio A.

Affiliation: National Public Health Institute, Helsinki, Finland.

Abstract: his study examined the relation between the intake of antioxidant vitamins and CHD risk. A cohort study pooling 9 prospective studies that included information on intakes of vitamin E, carotenoids, and vitamin C and that met specific criteria was carried out. During a 10-y follow-up, 4647 major incident CHD events occurred in 293 172 subjects who were free of CHD at baseline. RESULTS: Dietary intake of antioxidant vitamins was only weakly related to a reduced CHD risk after adjustment for potential nondietary and dietary confounding factors. Compared with subjects in the lowest dietary intake quintiles for vitamins E and C, those in the highest intake quintiles had relative risks of CHD incidence of 0.84 (95% CI: 0.71, 1.00; P=0.17) and 1.23 (1.04, 1.45; P=0.07), respectively, and the relative risks for subjects in the highest intake quintiles for the various carotenoids varied from 0.90 to 0.99. Subjects with higher supplemental vitamin C intake had a lower CHD incidence. Compared with subjects who did not take supplemental vitamin C, those who took >700 mg supplemental vitamin C/d had a relative risk of CHD incidence of 0.75 (0.60, 0.93; P for trend <0.001). Supplemental vitamin E intake was not significantly related to reduced CHD risk. The results suggest a reduced incidence of major CHD events at high supplemental vitamin C intakes. The risk reductions at high vitamin E or carotenoid intakes appear small.

Vitamin C and Risk of Coronary Heart Disease in Women

Source: Journal of the American College of Cardiology 2003; 42(2): 246-52

Author: Osganian S.K., Stampfer M.J., Rimm E., Spiegelman D., Hu F.B., Manson J.E., Willett W.C.

Affiliation: Department of Medicine, Children's Hospital, Boston, Massachusetts, USA.

Abstract: The objective of this study was to prospectively examine the relation between vitamin C intake and risk of coronary heart disease (CHD) in women. Results from prospective investigations of the relation between vitamin C intake and risk of CHD have been inconsistent. The lack of clear evidence for a protective association despite a plausible mechanism indicates the need to evaluate further the association between vitamin C intake and risk of CHD. In 1980, 85,118 female nurses completed a detailed semiquantitative food-frequency questionnaire that assessed their consumption of vitamin C and other nutrients. Nurses were followed up for 16 years for the development of incident CHD (nonfatal myocardial infarction and fatal CHD). During 16 years of follow-up (1,240,566 person-years), 1,356 incident cases of CHD were identified. After adjustment for age, smoking, and a variety of other coronary risk factors, a modest significant inverse association between total intake of vitamin C and risk of CHD was observed (relative risk [RR] = 0.73; 95% confidence interval [CI] 0.57 to 0.94). Among women who did not use vitamin C supplements or multivitamins, the association between intake of vitamin C from diet alone and incidence of CHD was weak and not significant (RR = 0.86; 95% CI 0.59 to 1.26). In multivariate models adjusting for age, smoking, and a variety of other coronary risk factors, vitamin C supplement use was associated with a significantly lower risk of CHD (RR = 0.72; 95% CI 0.61 to 0.86). the study concludes that users of vitamin C supplements appear to be at lower risk for CHD.

Coronary Heart Disease in Smokers. Vitamin C Restores Coronary Microcirculatory Function

Source: Circulation 2000; 102: 1233-1238

Author: Kaufmann P.A., Gnecchi-Ruscone T., di Terlizzi M., Schafers K.P., Luscher T.F., Gamici P.G.

Affiliation: From MRC Clinical Sciences Centre, Imperial College School of Medicine, Hammersmith Hospital, London, UK; and Cardiology, University Hospital, Zurich, Switzerland. Dr Schafers? current address is Klinik und Poliklinik fur Nuklearmedizin, Universitat Münster, Münster, Germany.

Abstract: Coronary endothelial function and vasomotion are impaired in smokers without coronary disease, and this is thought to be due to increased oxidative stress. In this study positron emission tomography was used to measure the coronary flow reserve, an integrated measure of coronary flow, through both the large epicardial coronary arteries and the microcirculation in 11 smokers and 8 control subjects before and after administration of the antioxidant vitamin C. At baseline, coronary flow reserve was reduced by 21% in smokers compared with control subjects (P<0.05) but was normalized after vitamin C, whereas the drug had no effect in control subjects. The present study is the first to demonstrate that the noxious prooxidant effects of smoking extend beyond the epicardial arteries to the coronary microcirculation and affect the regulation of myocardial blood flow. Vitamin C restores coronary microcirculatory responsiveness and impaired coronary flow reserve in smokers, which provides evidence that the damaging effect of smoking is at least in part accounted for by an increased oxidative stress.

Scurvy – Recent Cases and Research Findings

Gingival Hypertrophy: a Solitary Manifestation of Scurvy

Source: American Journal of Otolaryngology 2008; 29(6): 426-8

Author: Li R., Byers K., Walvekar R.R.

Affiliation: Department of Otolaryngology and Head Neck Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.

Abstract: A 48-year-old woman presented with rapid onset hypertrophy of both the upper and lower gingiva. A detailed history and a diet nearly void of fruits and vegetables raised the suspicion of a possible deficiency of vitamin C. An estimation of the serum ascorbic acid level confirmed our suspicions (<0.12 mg/dL; normal range, 0.4-1.0 mg/dL) and a diagnosis of scurvy was confirmed. A course of 1000 mg/d of ascorbic acid was initiated that caused a dramatic resolution of the gingival lesions. Gingival hypertrophy has a large differential diagnosis; however, it is also known to be an extremely rare manifestation of scurvy. A high index of suspicion for scurvy is relevant given its low prevalence in developed nations and how easily remediable the disease can be, even when it presents in a severe form.

Infantile Scurvy: an Old Diagnosis Revisited with a Modern Dietary Twist

Source: American Journal of Clinical Dermatology 2007; 8(2): 103-6

Author: Burk C.J., Molodow R.

Affiliation: Pediatric Dermatology, University of Miami, Miami, Florida 33125, USA.

Abstract: Scurvy, a disease of dietary ascorbic acid deficiency, is uncommon today. Indeed, implementation of dietary recommendations largely eradicated infantile scurvy in the US in the early 1900s. We present a case of an otherwise healthy 2-year-old Caucasian girl who presented with refusal to walk secondary to pain in her lower extremities, generalized irritability, sleep disturbance, and malaise. The girl's parents described feeding the patient an organic diet recommended by the Church of Scientology that included a boiled mixture of organic whole milk, barley, and corn syrup devoid of fruits and vegetables. Physical examination revealed pale, bloated skin with edematous, violaceous gums and loosening of a few of her teeth. Dermatologic findings included xerosis, multiple scattered ecchymoses of the extremities, and perifollicular hemorrhage. Laboratory and radiographic evaluation confirmed the diagnosis of scurvy. The patient showed dramatic improvement after only 3 days of treatment with oral ascorbic acid and significant dietary modification. In this case report, we revisit the old diagnosis of scurvy with a modern dietary twist secondary to religious practices. This case highlights the importance of taking a detailed dietary history when evaluating diseases involving the skin.

Scurvy in a 10-Month-Old Boy

Source: International Journal of Dermatology 2007; 46(2): 194-8

Author: Larralde M., Santos Munoz A., Boggio P., Di Gruccio V., Weis I., Schygiel A.

Affiliation: Pediatric Dermatology Division and Pediatric Department, Ramos MejŪa Hospital, Buenos Aires, Argentina

Abstract: This is a report of a 10-month-old boy with inflammatory and necrotic gingival lesions, fever, irritability, and pseudoparalysis of the legs. Laboratory examinations revealed moderate anemia and skeletal X-rays showed osteopenia, scorbutic rosary at the costochondral junctions, and "corner sign" on the proximal metaphyses of the femora. The boy had been fed only with diluted cow's milk. He had never taken solid food, vitamin C, or iron complement. Seventy-two hours after starting oral vitamin C supplementation, there was significant improvement in the patient's gingival lesions and general health. The clinical presentation and laboratory and imaging findings, together with the dramatic response to ascorbic acid intake, allowed us to confirm the diagnosis of infantile scurvy. Scurvy, a dietary disease due to the deficient intake of vitamin C, is uncommon in the pediatric population. In an infant who has never received vitamin C, the combination of gingival lesions, pseudoparalysis, and irritability strongly suggests a diagnosis of scurvy. The clinical picture, together with the laboratory data, radiological studies, and therapeutic response to vitamin C administration, confirmed the diagnosis.

Scurvy in Pediatric Patients: a Review of 28 Cases

Source: Journal of the Medical Association of Thailand 2003; 86 Suppl 3: S734-40

Author: Ratanachu-Ek S., Sukswai P., Jeerathanyasakun Y., Wongtapradit L.

Affiliation: Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand

Abstract: The objective of this retrospective study was to examined the dietary factors, clinical findings, plasma vitamin C level and post-treatment outcome of scurvy in pediatric patients at Queen Sirikit National Institute of Child Health. The medical and radiographic records of pediatric patients, diagnosed with scurvy at Queen Sirikit National Institute of Child Health from 1995 to 2002 were reviewed. Twenty-eight pediatric patients were diagnosed with scurvy. Their ages ranged between 10 months-9 years 7 months (median age of 29 months). 93 per cent of the cases were between 1-4 years of age. All were fed with well-cooked foods and small amounts or no vegetables and fruits. Supplementation with ultra heat temperature (UHT) milk was found in 89 per cent, average 5.8 boxes/day and 14.3 months in duration. Eighty-six per cent of cases were misdiagnosed previously. Clinical manifestations involved limp or inability to walk (96%), tenderness of lower limbs (86%), bleeding per gum (36%), fever (18%), and petechial hemorrhage (3.6%). All cases had abnormal radiographic findings compatible with scurvy and 2 cases had epiphyseal separation. All had clinical improvement within the first week after vitamin C supplementation. The study concludes that vitamin C deficiency was found in the children's intake of small amounts or no vegetables and fruits together with UHT-milk. Frequent manifestations were limping and inability to walk and pain in the lower limbs. Response to vitamin C treatment was dramatic.